1851428254 NPI number — SAN TAN SMILES FAMILY DENTISTRY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851428254 NPI number — SAN TAN SMILES FAMILY DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN TAN SMILES FAMILY DENTISTRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851428254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1355 S HIGLEY RD
Provider Second Line Business Mailing Address:
SUITE 114
Provider Business Mailing Address City Name:
HIGLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85236-4705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-457-8818
Provider Business Mailing Address Fax Number:
480-457-8785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1355 S HIGLEY RD
Provider Second Line Business Practice Location Address:
SUITE 114
Provider Business Practice Location Address City Name:
HIGLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85236-4705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-457-8818
Provider Business Practice Location Address Fax Number:
480-457-8785
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
MARY LOU
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
480-457-8818

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  2527 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com